Exposure-based treatments are the most effective psychosocial treatments available for anxiety disorders, and Exposure and Response Prevention (ERP) is the treatment of choice for OCD. Despite the efficacy of these treatments, services are difficult to access outside of anxiety specialty clinics and not accessible to low SES populations resulting in very few patients who actually receive this treatment. The broad objective of this proposed mentored Patient-Oriented Research Career Development (K23) Award is to promote the applicant's long-term goals of adapting exposure treatments for anxiety disorders to meet the needs of underserved populations and the community mental health settings that provide the majority of their services. The applicant's strong research and clinical background in phenomenology, course and naturalistic treatment of OCD provide an excellent foundation for this career development award. Her goal is to begin with a focus on OCD and adapting Exposure and Response Prevention (ERP) for low-SES populations and implementation in community mental health centers (CMHC) and then expand to other anxiety disorders. The mentorship team at Brown and Boston University offer an outstanding research environment to help accomplish the training goals of this K23: (1) develop expertise in adapting exposure treatments for underserved populations in community mental health settings; (2) increase knowledge of therapist training models and innovative teaching techniques for training community therapists to adopt evidence-based treatments, (3) develop expertise in the design and execution of clinical trials in community settings, (4) become skilled in treatment outcome and treatment process analysis methods, and (5) increase knowledge of cost-effectiveness analysis in order to collaborate with health economists to evaluate cost-effectiveness of behavioral interventions. The proposed research plan is in line with the NIMH strategic plan and is designed to meet the objectives of the NIMH From Intervention Development to Services Program (PAR-09-173). A series of three projects will be executed to adapt and pilot-test a team ERP (T-ERP) intervention that will optimize therapist time by utilizing paraprofessionals to assist with ERP treatment plans. The intervention will be tailored to meet the unique needs of low-SES individuals with OCD and be implemented in CMHC. In project 1, focus groups will identify local barriers to engaging, adapting, and implementing T-ERP with low SES individuals with OCD in a CMHC. Data will then be used to adapt ERP for use by teams of therapists and paraprofessionals by developing and evaluating a training program including competence and adherence scales. Project 2 aims to use a small open trial of patients to improve the clarity, structure, content, acceptability, and feasibility of the adapted intervention in a CMHC. Project 3 will consist of a randomized pilot trial of the intervention versus treatment as usual (TAU) in 60 outpatients with OCD. These projects will yield initial feasibility and acceptability data which will be used as pilot data for a full-scale RCT study. PUBLIC HEALTH RELEVANCE: As a result of this K-23 research plan, the candidate will have adapted ERP for low SES patients with OCD in a CMHC, tested its feasibility, acceptability, and initial efficacy, and will be prepared to test its efficacy and effectiveness in future R01 clinical trials. From a longer term perspective, this program of research will result in the adaptation of exposure-based treatments for underserved populations and will lead to other studies aimed at optimizing transportability, outcome and cost-effectiveness of available treatments for anxiety disorders.